Parent/Legal Guardian Information Full Name *
First Last Street Address * How did you hear about us? * Student Information Student Name *
First Last Student's address (if different from above) School Information Is student still enrolled at the school above? * What is student's disability according to the school? What is student's disability according to you? Please list the names and contact information for any medical providers (counselors, psychologists, pediatricians, behavioral analysts, etc.) who have treated your child for the above-listed disabilities. Does student have an IEP or 504 Plan? If so, please list any concerns you have regarding Student's IEP or 504 plan. If not, do you believe student should have an IEP or 504 plan? Has student been expelled or suspended from the school? If so, when and for how long? What were the school's reasons for doing so? Are you concerned about student's safety at school? If so, please describe your concerns. If you have other concerns regarding student's educational rights, please describe them. Is there any ADDITIONAL information you think we should know regarding your claim? Disclaimer
This Web page provides general information only and cannot be relied upon as legal advice. Laws change over time and differ from State to State. Applicability of the legal principles discussed may differ substantially in individual situations. You should consult an attorney about your particular situation. This site is not intended to be advertising, and our firm does not wish to represent anyone who wishes us to represent them based upon a review of this site if the site does not comply with the rules of that legal jurisdiction.
Do you accept or do you not accept this disclaimer?